International Journal of Healthcare Simulation

Background:

Enhanced recovery after surgery (ERAS) is an evidence-based approach in perioperative care allowing patients to recover more quickly after surgery. The ultimate aim of this programme is to optimize organ function pre-operatively and reduce the stress response from major surgery to aid in early recovery ^[1]. The multimodal pathways utilize a wide range of staff from the multi-disciplinary healthcare team. Although medical staff such as senior anaesthetists and surgeons may be confident in implementing ERAS protocols and troubleshooting post-operative problems, this may not be the case for more junior medical, theatre and nursing staff. This is of particular relevance in smaller surgical units across the UK.

Aims:

We aimed to provide structured and interactive simulation (SIM) training for staff involved in the management of colorectal surgery patients on the ERAS programme. Staff included operating department practitioners (ODPs), surgical staff nurses and anaesthetics senior house officers (SHOs). This was based at a small district general hospital (DGH) in the West Midlands.

Method:

Staff were given hypothetical post-operative scenarios of commonly encountered surgical problems on the ward. These included hypotensive patients and the management of regional analgesic techniques such as epidurals. Sessions were commenced with a brief and targeted outline of relevant physiology, followed by a series of SIM moulages. A longer period of time was made available at the end of each SIM for debrief.

Results:

Staff were more confident after SIM sessions in managing the acutely ill ERAS surgical patient. The multi-disciplinary nature of the scenarios was highly commended. Feedback from staff was encouraging, in particular, about how ‘real’ the scenarios felt. There was also increased awareness about the rationale behind the principles of the ERAS programme and healthcare staff felt it would change their practice. Feedback was measured through a series of pre- and post-SIM questionnaires.

Implications for practice:

Through a series of SIM sessions and theatre shadowing, we aim to create an ERAS team and ERAS unit at the hospital. SIM will play a major role in addressing the learning objectives of junior medical staff, ODPs and nurses. The long-term goal is to safely manage these patients on a dedicated unit. We aim to create a safe environment where invasive monitoring can be used, and treatments such as vasopressors prescribed under the supervision of anaesthetists. This will ultimately improve patient care and help fulfil the core objectives of the ERAS approach.